Kiesselbach Plexus

Kiesselbach plexus is a dense network of anastomosing (communicating) arteries located in the mucous membrane of the anteroinferior part of the nasal septum.

This anatomical area is of great clinical importance, as it is the source of more than 90 percent of all nosebleeds (epistaxis). This area is highly vulnerable due to superficial location and high density of blood vessels.

Anatomy and Pathophysiology

Kiesselbach plexus is unique since the terminal branches of both the external and internal carotid artery systems converge and form a network in this small area. The plexus is mainly formed by the anterior ethmoidal, sphenopalatine, greater palatine, and superior labial arteries.

The mucous membrane in the Kiesselbach area is very thin and prone to drying, especially when inhaling dry air. Any mechanical trauma, even minor (e.g., from a finger), or an increase in blood pressure can easily damage the vessels and cause bleeding.

Clinical Significance

Bleeding from the Kiesselbach area is called an anterior nosebleed. It is usually not life-threatening and can be stopped by conservative methods. It is diagnosed during anterior rhinoscopy, when a doctor sees the source of the bleeding.

First aid involves pressing the alae of the nose against the septum for 10–15 minutes while seated with the head tilted forward. If this does not help, a doctor may cauterize the bleeding vessel with silver nitrate or perform anterior nasal packing.